Specialist, Provider Network Administration (IOWA)

Summary

Molina Healthcare is a healthcare organization supporting health plan operations, including its Iowa Healthplan. The Specialist, Provider Network Administration provides support for provider network administration activities, including validating and maintaining provider information, auditing records, resolving configuration issues, and supporting network administration projects.

Responsibilities

• Receives information from outside parties for update of provider-related information in applicable computer system(s)
• Reviews/analyzes data by applying job knowledge to ensure appropriate information has been provided
• Maintains department quality standards for provider demographic data with affiliation and fee schedule attachment
• Ensures accurate entries of information into health plan systems
• Audits loaded provider records for quality and financial accuracy, and provides documented feedback
• Assists in resolution of configuration issues with applicable teams
• Provides support for provider network administration projects

Skills

• • At least 3 years of health care experience, to include experience in claims, provider services, provider network operations, and/or hospital/physician billing, or equivalent combination of relevant education and experience
• • Attention to detail, and ability to facilitate accurate data entry/review
• • Data entry/processing skills
• • Customer service skills
• • Ability to manage multiple priorities and meet deadlines
• • Effective verbal and written communication skills
• • Microsoft Office suite and applicable software programs proficiency
• • Experience with medical terminology, Current Procedural Terminology (CPT), International Classification of Diseases (ICD-9, ICD-10) codes, etc
• • Intermediate Microsoft Excel skills
• * Claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria

Qualifications

Must Haves

• • At least 3 years of health care experience, to include experience in claims, provider services, provider network operations, and/or hospital/physician billing, or equivalent combination of relevant education and experience
• • Attention to detail, and ability to facilitate accurate data entry/review
• • Data entry/processing skills
• • Customer service skills
• • Ability to manage multiple priorities and meet deadlines
• • Effective verbal and written communication skills
• • Microsoft Office suite and applicable software programs proficiency

Nice to Haves

• • Experience with medical terminology, Current Procedural Terminology (CPT), International Classification of Diseases (ICD-9, ICD-10) codes, etc
• • Intermediate Microsoft Excel skills
• * Claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria

Benefits

• Molina Healthcare offers a competitive benefits and compensation package.